July 2022 Department of Surgery Newsletter

SURGERY NEWS July 2022

NOTES FROM THE CHAIR We’ve made it through the first half of the year, and although the COVID-19 virus continues to be unpredictable, our work is advancing at a steady pace.

Our endeavors to train the next generation of surgeons resulted in the graduation of another outstanding class of residents. I continue to be very proud of those training on our campus in the midst of a worldwide pandemic.

I am also proud to congratulate our clinical partner, Children’s Hospital Colorado, which is once again ranked in the top 10 Best Children’s Hospitals in the country by U.S. News and World Report. Many of our faculty provide services at this outstanding facility and contributed to exceptional rankings for a number of specialties.

Over the past few months, we have hosted the only cardiothoracic surgeon from Rwanda, held our annual research symposium highlighting the exceptional work of many of our residents and their faculty mentors, and welcomed numerous new faculty and staff.

I hope you enjoy reading about our accomplishments highlighted in the following pages.

Richard D. Schulick, MD, MBA Professor & Chair, CU Department of Surgery Director, CU Cancer Center The Aragón/Gonzalez-Gíustí Chair

ISSUE HIGHLIGHTS

CONGRATULATIONS 2022 GRADUATES

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U.S. NEWS RANKINGS

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2022 RESEARCH SYMPOSIUM 12

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2 The graduating physicians honored at the University of Colorado Department of Surgery Resident and Fellow Graduation navigated portions of their training during a world-wide pandemic.

RWANDA COMES FROM DOCTOR TO DONOR TO COLORADO

Surgery News

DEPARTMENT OF SURGERY HONORS GRADUATING RESIDENTS AND FELLOWS FOR DEDICATION DURING CHALLENGING TIMES Graduates express gratitude for training and support they received from CU Department of Surgery faculty and staff.

Rachel Sauer The graduating physicians honored at the University of Colorado Department of Surgery Resident and Fellow Graduation navigated portions of their training during an unprecedented time.

The worldwide COVID-19 pandemic significantly altered not only surgery schedules and overall hospital operations, but the landscape of health care.

In the midst of this upheaval, “you showed a sense of duty, selflessness, grit, resourcefulness, and compassion, and you were very nimble reacting to the ups and downs of the pandemic,” said Richard Schulick, MD, MBA, chair 2

of the CU Department of Surgery. “I am so proud of your accomplishments.”

The graduates were recognized for completing surgery residencies or multi-year fellowships in the department’s multiple specialties, and in many instances further honored with awards from Department of Surgery faculty and their fellow residents.

Recognizing residents and faculty Among those awards was the Golden Apple Teacher of the Year Resident Award, this year presented to Rashikh Choudhury, MD, who completed a general surgery residency and

will continue his training in the CU Department of Surgery transplant surgery fellowship program. In the nomination for this award, Choudhury’s peers noted, “He made me feel integral to the team” and “He’s a true credit to the School of Medicine.”

Faculty members also were recognized, including Edward Jones, MD, associate professor of GI, trauma, and endocrine surgery and a U.S. Army reservist currently deployed. He was recognized with the Faculty Teacher of the Year Award presented by general surgery chief residents and honored as “an individual who exemplifies what cusurgery.com

July 2022 it means to be an academic surgeon and educator,” said presenter and graduating general surgery resident Jason Samuels, MD. “He’s also someone who is making immense sacrifices for his community.”

resident I’ve ever met in my life,” mentioned mixed emotions upon graduating.

Golden Apple Teacher of the Year Award - Faculty Caitlyn Lesh, MD

“I’m excited for the next chapter but sad to say I’m leaving what feels like my home now,” Tuaño said.

Golden Apple Teacher of the Year Award - Resident Rashikh Choudury, MD

In his written acceptance, Jones said, “You have “I’m honored learned, you to have had have endured, the privilege “I am so proud of your you have saved of working lives, and you accomplishments.”

Schulick alongside have proven you. The yourselves sense of ready,” Schulick accomplishment and joy in your faces told the graduates. “Similar to the quote as you became good surgeons is all from Roman general and emperor the thanks I need.”

Julius Caesar, ‘Veni, vidi, vici.’”

“Never forget the influence the faculty has had on you,” advised Mark Nehler, MD, program director of surgery residency and professor of vascular surgery. “You’re going to go 2021-2022 out and start getting a lot of different Award Winners voices in your ears, and realize you Bartle Faculty Teaching Award don’t fully appreciate your training until Edward Jones, MD you’re done. But you went through multiple years of the pandemic, and J. Cuthbert Owens Award you rose to the occasion and did Robert Torphy, MD, PhD what’s necessary.”

Todd Arcomano, MD Intern of the Year Excited for the next chapter Benjamin Ramser, MD Graduating surgical fellows also Ernest E. Moore Award in Basic were recognized for the skills and Science Research enthusiasm that they brought to their Robert Torphy, MD, PhD various programs. In recognizing Frederick L. Grover Award in Clinical graduating cardiothoracic surgery Science Research fellows Yihan Lin, MD, and Brandon Jason Samuels, MD Wojcik, MD, chief of cardiothoracic surgery David Fullerton, MD, praised Eiseman Research Award in Basic both for what they brought to the CU Science Research School of Medicine. He noted Lin’s Robert Torphy, MD, PhD passion for the betterment of surgical Ben Eiseman Research Award in care in low-income settings and how Clinical Science Research “she single-handedly arranged for the Adam Dyans, MD first cardiothoracic surgical fellow to visit us from Rwanda.”

Ben Eiseman Teaching Award Wojcik noted that, “Surgical training has tough days and sometimes direct, real-time feedback. We call that a beat.

But a beat is just a hug that hurts.”

Graduating plastic and reconstructive surgery fellow Krystle Tuaño, MD, whom plastic and reconstructive surgery professor David Mathis, MD, praised as “the hardest-working

Alden Harken Clinical Research Award Kelly Higa Anessa Sax-Bolder John DeLauro Scholarship Ann Rowland Clinical Faculty Professionalism Award Sarah Tevis, MD Research Faculty Professionalism Award Carlos Zhgeib, PhD Resident/Fellow Professionalism Award Rashikh Choudury, MD Advanced Practice Provider Clinical Excellence Award - Outpatient Whitney Herter, PA-C Advanced Practice Provider Clinical Excellence Award - Inpatient Steffen Meiler, PA-C Advanced Practice Provider Excellence in Practice Award- Junior Resident Nicholas Schmoke, MD Advanced Practice Provider Excellence in Practice Award - Senior Resident Julia Coleman, MD

Hunter B. Moore, MD, PhD Owens-Swan Award for Promising Career in Surgery Jessica Hall George Packard Award for Outstanding Performance Jessica Hall Madison Harrison

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Surgery News

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U.S. NEWS RANKS CHILDREN’S HOSPITAL COLORADO AMONG TOP 10 NATIONWIDE Clinical partner of CU School of Medicine has five specialties in the top 10.

School of Medicine Children’s Hospital Colorado is once again ranked among the top 10 children’s hospitals in the country by U.S. News and World Report. The magazine released its 2022–23 Best Children’s Hospitals rankings, and Children’s Colorado is ranked number 7 nationally and number 1 in the Rocky Mountain region and state of Colorado.

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Five pediatric specialties also placed in the top 10 — including numberfour rankings for diabetes and endocrinology and gastroenterology and gastrointestinal surgery.

APPLY NOW

Children’s Colorado is affiliated with the University of Colorado School of Medicine. Services at Children’s Hospital are provided by many of our Department of Surgery faculty.

Click here to view all open positions.

pulmonology and lung surgery at number 6, urology at number 7, and cancer at number 8.

The annual U.S. News Best Children’s Hospitals rankings were introduced in 2007 and offer guidance for families of children seeking the best medical care for rare or lifethreatening illnesses. The U.S. News methodology factors objective measures such as patient outcomes, including mortality and infection rates, as well as health equity and available clinical resources and compliance with best practices. The top 50 medical centers are ranked in 10 specialties surveyed on nearly 2,000 data questions, as well as a reputation survey sent to thousands of pediatric specialists nationwide.

Other top 10-ranked specialties for Children’s Colorado include 4

cusurgery.com

July 2022

WELCOME NEW HIRES FACULTY Ashley Arkema, NP Instructor Surgical Oncology McCall Chapman Instructor Surgical Oncology Elizabeth David, MD Associate Professor Cardiothoracic Surgery Colton Davies, PA Instructor Pediatric Surgery Samantha DeYoung, PA-C Instructor Cardiothoracic Surgery Brittany Glassett, PA-C Instructor Transplant Surgery Junyi Hu, MD Research Associate Plastic & Reconstructive Surgery Alexandra Huechteman, PA-C Instructor Cardiothoracic Surgery

Benjamin Nigg, PA-C Instructor Plastic & Recontructive Surgery

Sophia Gordon Lab Coordinator Center for Surgical Innovation

Jodi Sagastume, PA-C Instructor GI, Trauma, & Endocrine Surgery

Elizabeth Katsnelson Research Services Professional Surgical Oncology

Lauren Schneider, CPNP-AC/PC Instructor Pediatric Surgery

Jill Ketzer Colorectal Research Project Manager Pediatric Surgery

John Shaw, PA Instructor GI, Trauma, & Endocrine Surgery

Shannon Lamoree Program Coordinator Finance & Administration

Hope Simmons, CPNP-AC Instructor Pediatric Surgery

Sarah Miller Business Services Program Manager Finance & Administration

Heather Stuart, PA-C Instructor GI, Trauma, & Endocrine Surgery

Tien Ngo Research Services Professional Cardiothoracic Surgery

Jason Yu, DMD, MD Assistant Professor Plastic & Reconstructive Surgery

Brittney Reyes Surgery Program Administrator Finance & Administration

Eric Zarzeczny, NP Instructor GI, Trauma, & Endocrine Surgery

Jessica Slattery Website & Digital Content Specialist Plastic & Reconstructive Surgery Nora Suarez Business Services Professional Pediatric Surgery

Melford Lazarte, DNP Instructor Transplant Surgery

STAFF

Yuhuan Luo, MD Research Associate Plastic & Reconstructive Surgery

Jennie Almeida Surgery Program Administrator Finance & Administration

Jihong Ma, MD, MS Assistant Professor Plastic & Reconstructive Surgery

Whitney Baylor Health Care Professional Surgical Oncology

Elisha McGuire, CPNP-AC Instructor Pediatic Surgery

Kristen Brown Research Clinical Services Professional Transplant Surgery

Monique Minter, PA-C Instructor Cardiothoracic Surgery

Jin Cha Research Services Professional Urology

Michael Moore, PA Instructor GI, Trauma, & Endocrine Surgery

Diego Escobar-Garcia Research Services Professional Finance & Administration

Robyn Moore, PA-C, MPH Instructor Pediatric Surgery

Meredith Funke Project Manager II Finance & Administration

Sarah Williams Post Award Specialist Finance & Administration Jennifer Yang Entry Program Coordinator Finance & Administration

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Surgery News type medications they get from friends at the gym, but they don’t have a full understanding of what those medications really can do to you. So many young men use these medications in that way, and they have no idea whatsoever that they are shutting off their own fertility, potentially permanently.

What causes that damage to fertility?

LOW TESTOSTERONE: SEPARATING FACT FROM FICTION John Dodge, PA, of the CU Department of Surgery, addresses common misconceptions about testosterone therapy.

Greg Glasgow Men looking for information on their physical and sexual health often turn to the internet, where low testosterone is a commonly searched — and commonly misunderstood — topic.

We spoke with John Dodge, PA, an instructor of urology in the Department of Surgery at the University of Colorado School of Medicine, about testosterone and related effects on mental and physical health.

Low testosterone is a big topic online and on social media, especially among younger men. What’s most important for that population to know about the subject?

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John Dodge, PA Instructor Urology

Low testosterone is a huge topic, and unfortunately, there’s so much misinformation about testosterone out there. There are freestanding men’s health clinics that paint a really unrealistic picture of what a man can expect from testosterone therapy — that it can reverse aging or revitalize sexuality. It leads to really poor expectations of what testosterone therapy can do. Patients come in who’ve seen this type of advertising, or they’ve talked to a friend, or they’ve seen some kind of messaging on social media, that, “If you have these symptoms, you need to be on testosterone, or your testosterone level needs to be higher.” And it’s far from the truth, for the most part.

There is a regulation system in men called the hypothalamic-pituitarygonadal axis. That’s what regulates testosterone production and sperm production. When we introduce testosterone from the outside, we’re disrupting that system. It’s a supremely delicate balance, and if we don’t have a very good reason for administering testosterone, we have the potential to do some great harm. Not only are we shutting off their testosterone production, we’re also shutting off their sperm production. And it’s not as easy as, “Stop using the testosterone and you’ll go back to normal.” It could take six, 12, 24 months before we see sperm production resume, but it could also result in a permanent suppression of sperm production. It’s impossible to predict if someone is going to be one of those lucky men whose production actually resumes, versus one of the more unfortunate men who have caused permanent harm as far as their ability to father children.

Click here to read our entire interview with Dodge.

I see a fair number of men in their 20s and 30s who are using testosterone-

cusurgery.com

July 2022 really be showcased for their hard work with the faculty over the past few years,” said Robert Meguid, MD, MPH, associate professor of cardiothoracic surgery.

That research includes work done by Jason Samuels, MD, who looked at the impact of bariatric surgery on the health care costs of patients who are obese. In analyzing data from about 5,400 patients who had bariatric surgery, he found that 3,100 patients went to the emergency room at least once in the two years following surgery, but fewer than 10% of those patients were admitted to the hospital.

GENERAL SURGERY RESIDENTS PRESENT RESEARCH AT ANNUAL SYMPOSIUM The ninth annual Department of Surgery Research Symposium highlights a spectrum of research in basic and translational science and clinical and health science.

Rachel Sauer Through analyzing post-operative outcome data for more than 5.5 million patients, Helen Madsen, MD, found that patients who are overweight or obese are at increased risk for postoperative infection, blood clots, and renal complications.

“This symposium really celebrates the research activities in the Department of Surgery,” said Richard Schulick, MD, MBA, chair of surgery. “Thanks to all the residents and trainees for really pushing our department up there in terms of research activities.”

Anna Gergen, MD, found through animal modeling that simvastatin, a drug commonly prescribed to help lower bad cholesterol and raise good cholesterol in the blood, shows potential in preventing the development and progression of esophageal injury caused by reflux.

Showcasing the importance of research during residency

Their research was among the 16 projects presented at the ninth annual University of Colorado Department of Surgery Research Symposium to highlight the research conducted by general surgery residents.

An important aspect of the general surgery residency program is dedicated time for research. The 16 general surgery residents who presented at the symposium conducted research in basic and translational science or clinical and health science, working with faculty mentors through the process.

“This is an incredibly important day where our research residents can

Because emergency room visits can represent a significant expense for patients, “what tools will help patients avoid the emergency room?” he said, indicating possible considerations for further research.

Julia Coleman, MD, found through her research studying the mechanism for sex dimorphism, or different characteristics shown by sexes of the same species, in coagulation that “female and male coagulation are not the same,” she said. Her research hypothesis proposes that estradiol, a hormone often used to treat menopause symptoms, has a procoagulant effect.

Success versus fulfillment An added highlight of the Research Symposium was a presentation

by Amir Ghaferi, MD, MS, director of the Michigan Bariatric Surgery Collaborative and associate professor of surgery and business at the University of Michigan Medical School.

He encouraged the residents and faculty in attendance to say yes to opportunities that challenge them and encourage them to grow, while also making thoughtful decisions about pursuing success or fulfillment.

Click here to learn more about their research.

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Surgery News

“ONE IN A BILLION ODDS” With support from a multidisciplinary care team at CU, a Colorado man receives a donor liver 45 minutes after getting onto the transplant list.

Rachel Sauer It happened so fast, and it was so unexpected.

then onto the liver transplant list very soon after.

In August 2020, Mario Carrasco got what he suspected was COVID-19 and took Tylenol to combat his high fever.

When that didn’t work, he took an antibiotic he had received from Mexico and eventually felt better. For several months afterward, he felt fine. He felt like he always does.

Less than an hour after getting onto the transplant list, he was being prepped for surgery. A compatible donor liver was on its way.

But then his stomach started hurting.

He felt nauseous and couldn’t keep food down. He turned yellow. During a visit to Montrose Memorial Hospital in Montrose, Colorado, physicians informed him that his liver enzymes were high, indicating inflammation.

And he quickly got worse, to the point that on April 28, 2021, he was flown to UCHealth University of Colorado Hospital in Aurora.

Over more than a week, the terrifying downward spiral continued as his liver failed and his family scrambled for options since he had entered the hospital uninsured and couldn’t get on the transplant recipient list without insurance. However, with a lot of work and support from a multidisciplinary care team, he got insurance through a significantly expedited process and 8

“The likelihood of getting a transplant the same day you’re put on the list is extremely rare, almost unheard of,” says Elizabeth Pomfret, MD, PhD, chief of transplant surgery in the University of Colorado Department of Surgery.

“What makes Mario’s experience so rare is the fact that we were able to get not only his insurance fast-tracked, but his approval for the transplant list, which usually takes many days to do.”

Feeling well, then a quick decline For most of his life, Carrasco, 54, has enjoyed good health. Since coming to the United States from Chihuahua, Mexico, in 1992 and settling with his family in Delta, Colorado, he built a career in construction – working hard and then coming home to his wife, Maria, and children, Carlos, Ivan, and Jennifer, all now adults.

He figured he would be fine after rebounding from what he thought was COVID-19 in August 2020. But

Elizabeth Pomfret, MD, PhD Professor & Chief Transplant Surgery

Monica Grafals, MD Associate Professor Renal Diseases & Hypertension then he started feeling poorly and things just kept getting worse. A blood draw indicated his liver enzymes were elevated, and by the time his wife and daughter took him to Montrose Memorial Hospital, they were even higher.

“They told us he had the option of going to Grand Junction or Denver, but the liver specialist was in Denver, so they flew him out to Denver,” explains Jennifer Carrasco. “Even then, he didn’t think it was anything serious.”

Carrasco was in the hospital for less than two weeks “when everything cusurgery.com

July 2022 started to go down,” he recalls. He had an internal normalized ratio (INR) test, which shows how quickly the blood clots, indicating how well the liver is working by producing enough proteins.

A normal INR is 1.0; Carrasco’s was 4.0, an alarming number indicating extremely slow blood clotting and poor liver function.

Perhaps even worse, during this time his father-in-law died, so his health worries were compounded by grief.

And then he had a seizure.

“We had talked with him the night he had the seizure and he seemed fine,” recalls Carlos Carrasco. “But then he was unconscious for almost two weeks, they call it a hepatic encephalopathy coma.” Hepatic encephalopathy happens when a damaged liver is unable to remove toxins from the blood, which can impact brain function.

Trying for a transplant “My mom was the one who asked if his liver could be salvaged, but they said it was pretty bad and more than likely he was going to need a transplant,” Jennifer Carrasco says.

“The damage was too advanced.”

Grafals and her Spanish-speaking colleagues, with support from Pomfret and the Division of Transplant Surgery, started the clinic in October 2018 in response to significant need in traditionally underrepresented Hispanic communities. Between October 2018 and October 2021, clinic faculty saw a 300% increase in Hispanic patients accessing clinic services.

“When Dr. Grafals came and spoke to the transplant team, she was focusing on kidney patients, but I was thinking this would be applicable for patients with liver failure,” Pomfret says.

“It was like hitting the lottery, it’s a case of one in a billion odds, the stars aligning and everything falling into place.”

– Pomfret

However, Carrasco at first couldn’t be added to the liver transplant registry because he lacked medical insurance.

Carlos and Jennifer Carrasco started a GoFundMe campaign that ultimately raised more than $18,000, “but we researched it and it said that transplants can cost $250,000 to $500,000, something like that, plus after a transplant you need insurance for anti-rejection medicine the rest of your life, which is really expensive, and follow-up checkups,” Carlos Carrasco says. “Some of our family members were going to see if they could borrow whatever it would cost, but it was just too much money. Our hopes were low, and then they said they were going to put him in hospice.”

This is the point, though, when Pomfret, tchief of transplant surgery at UCHealth, thought about a lecture that Monica Grafals, MD, an associate

professor of clinical practice in the CU School of Medicine and kidney transplant specialist with UCHealth, gave to the CU transplant surgery team about the Hispanic Transplant Clinic.

“That’s when the head of transplant hepatology said, ‘We’ve got a guy who’s been sitting in the hospital here for the past two weeks, he has acute liver failure but he seems fine from all other perspectives.’”

“Like hitting the lottery” Pomfret credits a multidisciplinary approach to patient care for the next steps in Carrasco’s journey. She asked Grafals whether Carrasco could enroll in the Denver Health Medical Plan’s Elevate Exchange, a local, nonprofit health insurance company that is part of the Colorado health insurance marketplace. “This is why integrated, multidisciplinary programs are so vital for the best patient care,” Pomfret says.

Working closely with Grafals and other team members from the Hispanic Transplant Clinic, Carrasco’s family dove into the paperwork with a fervor fueled by the seriousness of his situation. Grafals went so far as to

contact state legislators to ask whether there was any reason his insurance application couldn’t be expedited.

“He’s a wonderful man with a very special and loving family,” Grafals says. “We wanted to do absolutely everything we could do help him because his situation was desperate.

He was in acute liver failure.”

The definition of acute liver failure “is you have a 90% chance of death very soon, sometimes within days,” Pomfret explains. “That’s where he was at. I never thought we’d get a deceased liver in time, so we were looking into whether there was somebody from the family who could donate.”

But thanks to expedited paperwork, Carrasco was able to access Elevate Exchange coverage and get onto the liver transplant recipient list. Within 45 minutes of getting on the list, as Carlos Carrasco was filling out some final paperwork, “I heard about this liver,” Pomfret says.

It was a deceased donor liver, and it was already in Denver but the initial intended recipient either wasn’t healthy enough for transplant or had died before receiving it. And it was a match for Carrasco.

“It was like hitting the lottery,” Pomfret says. “It’s a case of one in a billion odds, the stars aligning and everything falling into place: the fact that the insurance was fast-tracked when often that process can take weeks, the expedited process for getting him onto the transplant list, and then how fast he matched with a donor liver. He was almost out of time when I got the call about this liver. I said, ‘Great, we’ll take it’ and within an hour of him getting on the list, we were heading into surgery.”

Click here to read more about Carrasco’s journey.

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Surgery News How it begins For most patients, Kukreja says, the first warning sign of bladder cancer is blood in the urine. Though this can be caused by other conditions — including urinary tract infections and enlarged prostate — it’s important to be checked thoroughly if you do notice blood in your urine, she says.

WHAT TO KNOW ABOUT BLADDER CANCER Janet Kukreja, MD, talks diagnosis, treatment, and causes of bladder cancer.

Greg Glasgow The American Cancer Society estimates 81,180 new cases of bladder cancer will be diagnosed in 2022.

We spoke with Janet Kukreja, MD, assistant professor of urology in the Department of Surgery at the University of Colorado School of Medicine, about the diagnosis, treatment, and causes of bladder cancer.

Research and treatment Kukreja is the principal investigator on a set of clinical trials researching medications for non-muscle invasive bladder cancer, the most common type of bladder cancer and one in which the tumor remains confined to the bladder lining and does not invade the bladder wall. More than 75% of bladder cancers are non-muscle invasive; the other type, muscle-invasive, are cancers that have invaded the bladder wall or spread outside of the bladder.

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Janet Kukreja, MD Assistant Professor Urology

“It’s an exciting time in the field of bladder cancer,” Kukreja says. “We have a lot of new medications we didn’t have before, and we’re really working on tailoring our therapy so that the right patient gets the right medications, radiation, or surgery at the right time.”

As non-muscle invasive bladder cancer has a 50% recurrence rate, Kukreja’s research is especially important in keeping the non-muscle invasive type from turning into muscle-invasive bladder cancer, which can become metastatic and deadly.

“With these trials, we’re hoping to improve treatment so that patients don’t have to go on to bladder removal, and they don’t have their disease progress to muscle-invasive disease,” she says.

“With an up to 50% recurrence rate, we have a lot of room for improvement in how we manage these patients.”

“If we do a CT scan and/or cystoscope in the office that shows that there’s a tumor in the bladder, we will take the patient to the operating room, remove the tumor, and send it to pathology,” she says. “That gives the grade and the stage of the cancer, and our treatment recommendations are based entirely off of those two things.”

The stage of the cancer is determined by the size of the tumor and how far it has spread within or beyond the bladder, while the grade is either low — cancer that looks more like normal bladder tissue — or high.

High-grade bladder cancer looks less like normal bladder tissue and is more likely to grow into the bladder wall and spread beyond the bladder; patients with low-grade bladder cancer usually have a good prognosis.

Common questions When people are diagnosed with bladder cancer, Kukreja says, they usually want to know what the treatment options are. For bladder cancer, treatment runs the gamut from surgery to chemotherapy, immunotherapy, radiation, and targeted therapy. Kukreja recently concluded a study on bacillus Calmette-Guerin (BCG), an immunotherapy drug for treating early-stage bladder cancer. BCG is a weakened bacterium that was originally developed as a vaccine to protect against tuberculosis.

Click here to read more about bladder cancer.

cusurgery.com

July 2022 bacteria in the lungs, suggesting that bacteria that migrate from the intestine to the lungs may partially be responsible for the poor outcomes in older individuals.

HOW A LEAKY GUT LEADS TO INFLAMED LUNGS New CU Department of Surgery research investigates the role of gut bacteria in pneumonia infection in the elderly.

Greg Glasgow Why are older adults more likely to get seriously ill or even die from pneumonia?

It turns out the cause may have as much to do with the gut as it does with the lungs.

That’s according to new research from Rachel McMahan, PhD, assistant research professor of GI, trauma, and endocrine surgery in the University of Colorado School of Medicine, and CU School of Medicine immunology graduate student Holly Hulsebus.

In a paper published in March in the journal Frontiers in Aging, the researchers — along with senior author Elizabeth J. Kovacs, PhD, professor of GI, trauma, and endocrine surgery — looked at the bacteria Streptococcus pneumoniaein in animal models, studying changes in intestinal microbial populations after infection.

Rachel McMahan, PhD Assistant Professor GI, Trauma, & Endocrine Surgery

“Streptococcus pneumoniae is normally carried in the nasal passages of healthy adults. People with healthy immune systems can just live with it, and it doesn’t cause any problems,” Hulsebus explains. “But people with compromised immune systems, including older adults, tend to become more susceptible because their immune system can’t really control the bacteria that are normally there. Those bacteria can leave the nose and move to other places in the body. They can cause ear infections, and they also can spread to the lungs and cause pneumonia.”

A likely reason for that migration, McMahan says, is that as we age, our guts become “leaky” as the mechanisms the body has in place to keep gut bacteria in place start to break down. This is similar to what happens with burn trauma patients and people who abuse alcohol. Compounding the problem is that inflammation in the body naturally increases with age, causing more pro-inflammatory bacteria to be present in the gut.

In their published study, funded by the National Institute on Alcohol Abuse and Alcoholism at the National Institutes of Health, the researchers found elevated levels of the Enterobacteriaceae family of bacteria — a gut-specific bacteria that includes E. coli— in the lungs of aged, but not young animal models, infected with Streptococcus pneumoniae. As Enterobacteriaceae is associated with increased inflammation, the researchers also discovered higher levels of neutrophils, a type of inflammatory immune cell, in the lungs of the aged infected animal models.

“Our working theory is that as you age, you have a heightened baseline inflammatory response, which then induces the gut to be more proinflammatory,” McMahan says. “That causes potentially pathogenic bacteria in the gut to leak out into the organs, and then things can go downhill fast.”

Click here to learn more about McMahan’s research.

The role of the leaky gut In addition to increased morbidity and impaired lung function after a Streptococcus pneumoniae infection in older mice, the researchers also found elevated levels of gut-derived

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Surgery News

BRINGING RWANDA’S ONLY CARDIOTHORACIC SURGEON TO COLORADO Maurice Musoni, MD, recently traveled from Kigali to work with CU Department of Surgery colleagues for a week.

Rachel Sauer Before Maurice Musoni, MD, completed his surgical training in South Africa, his home country of Rwanda had no cardiothoracic surgeon.

This was a concern for many reasons, especially with the continuing prevalence of rheumatic heart disease among Rwandans age 12 to 40. This debilitating, sometimes fatal condition is caused by untreated infections, such as strep throat or scarlet fever, that permanently damage heart valves.

In high-resource countries, these infections are commonly treated with antibiotics and rarely lead to rheumatic heart disease. But in sub-Saharan African nations, it’s much more common for untreated infections to cause the disease.

So Rwanda needed a heart surgeon, and in 2019 Musoni returned home after completing his training in South Africa.

While he feels the significant weight of the responsibility he carries, he has 12

continually sought opportunities and partnerships with clinicians around the world to grow and strengthen Rwanda’s capacity for treating cardiac conditions and diseases.

Friendship leads to global partnership One such partnership is with the University of Colorado Department of Surgery. Yihan Lin, MD, MPH, a recently graduated cardiothoracic surgery fellow in the department, met and became friends with Musoni while completing a two-year Paul Farmer Global Surgery Research fellowship in Rwanda through Harvard Medical School.

Inspired by their collaboration in Rwanda, Lin began working with colleagues in the CU Department of Surgery to establish a two-way knowledge- and skill-sharing relationship between clinicians in Colorado and Rwanda.

Because of this relationship, Musoni and his wife, Diane Umulisa, a hematology resident in Tanzania and at Rwanda Military Hospital in Kigali, recently spent a week in Aurora with CU Department of Surgery colleagues – observing procedures, attending presentations, and meeting with program administrators.

“There’s a lot to learn from programs and processes here (in Colorado),” Musoni says. “Now I’m thinking about how we build programs in Rwanda that are not a duplicate of the program here, but that adapt what works well for our context. I’m thinking about how we can do it cheaper; how we can design quality surgical programs with fewer resources.”

Making the world a smaller place Before Musoni decided to pursue medicine, the nearest example to the profession he had in his family was an uncle who is a veterinarian. The cusurgery.com

July 2022 genocide against the Tutsi in 1994 had completely decimated the health care infrastructure and the country had lost a big proportion of its human resource.

Rwanda was rebuilding steadily, and Musoni intended to be part of that renaissance.

Musoni decided to become a doctor, and two of his brothers followed his example. He earned his medical degree at the University of Rwanda, but opportunities to train as a cardiothoracic surgeon were not available. Therefore, he was sent to train at the University of Witwatersrand in Johannesburg, South Africa.

While completing his fellowship, he also began establishing his role as a clinician in Rwanda, which is how he met Lin.

Richard Schulick, MD, MBA, chair of surgery in the CU Department of Surgery, adds, “Our health care system in the U.S. is far from perfect, but we certainly have the ability and responsibility to collaborate with other countries to assist in establishing their health care structures, increasing their capabilities, and training their future caregivers. This is totally consistent with our vision to ‘Improve Every Life.’”

For Musoni, an international approach to surgical practice has been an important facet of his career. He serves as a clinical team coordinator for Team Heart, a Boston-based nonprofit organization established after the Rwanda Ministry of Health in 2007 asked the international medical community for assistance in addressing the growing issues of non-communicable disease.

Lin lived in Rwanda for two years while completing her global health fellowship and saw the need for knowledge and skill sharing between “Our goal is to save lives, so as our clinicians from highcardiac program grows, we are resource countries asking ourselves how we can be and medium- or lowmore efficient, how we can do more resource countries.

with the resources we have. In that

“I think the world is way, we can serve not only Rwanda, becoming smaller,” but the area around us - Musoni Lin explains. “There are so many things we can learn from our colleagues working in lower-resource Through Team Heart, medical groups settings. So often, they’re much more from around the world come to adaptable and resourceful in working Rwanda to work on-site with Rwandan within their means, and I think there are medical colleagues in addressing lessons we can learn from each other medical issues stemming from limited from multiple standpoints.” access to health care. In particular, Adapting to available resources Team Heart volunteers work with Rwandan colleagues on issues related Several years ago, Lin and about 65 to rheumatic heart disease. colleagues from the CU Department of Surgery ran a marathon to establish a fund that would support Rwandan clinicians visiting Colorado.

“We previously had residents from CU go to Rwanda for rotation, but it’s important that this isn’t a one-way relationship with just us going there,” Lin says. “Because travel from Rwanda to the U.S. can be very expensive, we wanted to establish a fund to support clinicians coming here.”

Musoni says collaborations with colleagues from around the world have helped him and other clinicians on the vanguard of Rwandan health care to see examples of programs they can adapt to the needs of Rwandans and modify to the country’s available resources. While Musoni’s surgical practice is based at King Faisal Hospital Kigali, he is working with colleagues to set up an anticoagulation clinic, as well as

to expand access to surgery that replaces damaged heart valves with artificial ones.

Training the next generations of surgeons “Cardiac surgery is extremely expensive, but expense can’t be the ultimate concern,” Musoni explains.

“Our goal is to save lives, so as our cardiac program grows, we’re asking ourselves how we can be more efficient, how we can do more with the resources we have. In that way, we can serve not only Rwanda, but the area around us.”

In his role as Rwanda’s only cardiothoracic surgeon, Musoni divides his time between the operating room and the seemingly endless list of administrative tasks, planning, and advocacy that attend his role in leading the establishment of cardiac programs in Rwanda.

Visiting the CU Department of Surgery is valuable not only in observing procedures and building relationships, he says, but in talking with administrators about creating sustainable frameworks for cardiac programs. He is especially passionate about building programs in Rwanda that allow medical students and surgical trainees to receive their education in-country.

“It’s easy to become so focused on the daily work of being a doctor that we forget about trainees,” Musoni says.

“But it’s absolutely essential that we are able to produce the next generations of surgeons, so now we’re thinking about what it will take for us to do that.”

Yihan Lin, MD, MPH Cardiothoracic Fellowship Alumna

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Surgery News Training and simulation Stewart received a $550,000 grant from Intuitive, maker of the SimNow Robotic Training Simulator, to bring a robotic training console to campus to give residents experience using the equipment. The new robotic surgery curriculum includes an orientation, online modules, robotic labs, and specific educational milestones, all leading to a robotic equivalency certificate that can make departing residents more attractive to potential employers.

ROBOTIC CURRICULUM TRAINS GENERAL SURGERY RESIDENTS IN CUTTING-EDGE TECHNOLOGY New robotic surgical equipment expands the training curriculum for residents.

Greg Glasgow Camille Stewart, MD, assistant professor of surgical oncology in the University of Colorado School of Medicine, is leading general surgery residents on valuable training with new robotic surgical equipment that is becoming more and more common in the world of medicine.

“Robotic-assisted surgery has been FDA-approved since 2000, but it’s become much more prevalent in recent years,” says Stewart, who became director of robotic education for the general surgery residency program for the CU Department of Surgery in 2021.

“It now comprises 15% of all general surgery operations, and it’s used by more than a third of general surgeons.

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Camille Stewart, MD Assistant Professor Surgical Oncology

Because it’s so commonly used, it’s really important for our graduates to know how to use this technology.”

Commonly used in surgeries including cholecystectomy, colectomy, hernia repair, reflux surgery, and cancer surgery, robotic surgery is a type of minimally invasive surgery in which a surgeon-controlled robot is used to perform procedures. The robot enables high-definition visualization and a high degree of dexterity due to wristed instruments, allowing for operations that, when compared to traditional longincision surgery, can result in smaller incisions, less pain, and faster recovery.

“It’s a lot like learning how to drive a car,” Stewart says of the training console, which uses surgical simulation to get residents familiar with the equipment. “You have to use both your hands, and you have to use both your feet. Part of what the robotic training simulator is for is that the first time they’re sitting at that console, they feel comfortable with the equipment, they feel comfortable with the technology.”

Robotic surgery typically occurs with a surgeon at the console, controlling the robotic equipment, and an assistant at the bedside to exchange instruments and adjust the robot as needed. Too often, Stewart says, residents were taking the bedside role, leaving them with little to no console experience.

Now with recently hired dedicated bedside robotic surgery assistants, residents can spend more time at the console.

“In all of our ORs, we have two consoles next to each other to enable education,” Stewart says. “This allows our residents to also be at the console and start learning how to actually do the robotic surgery, and not just assist at the bedside.”

Click here to read more about robotic surgery.

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July 2022

SOCIALLY VULNERABLE COLECTOMY PATIENTS ARE AT GREATER RISK FOR POST-OPERATIVE COMPLICATIONS Recently published research by CU surgery resident shows that social vulnerability is related to complications following surgery.

Rachel Sauer Patients who come from socially vulnerable backgrounds are at greater risk for complications following colon surgery, recently published research has found.

The study, led by Heather Carmichael, MD, a general surgery resident in the University of Colorado Department of Surgery, analyzed data from five UCHealth hospitals relating to patients who had a colectomy, a surgical procedure in which all or part of the colon is removed, between 2012 and 2017.

Analyzing post-operative complications including wound infections, respiratory complications, and sepsis, among others, Carmichael and her coresearchers found that patients from communities with higher social vulnerability had higher rates of postoperative complications.

Heather Carmichael, MD General Surgery Resident

“We need to start looking at barriers to surgical care,” Carmichael says. “How do we develop innovative strategies to address those barriers?”

These complications may be caused, in part, by delays in seeking care, so that patients with higher social vulnerability more often came to the hospital with sepsis or with a condition requiring emergency surgery.

Click here to learn more about Carmichael’s research.

MEDICAL STUDENT WINS AWARD FOR PRESENTING PAPER ABOUT SURGICAL TRAINING TOOL Second-year medical student Courtney Mangham was recognized for her presentation by the Association of Program Directors in Surgery.

Rachel Sauer It’s not unusual for students to enter medical school with ideas about paths they’d like to pursue in medicine. Those ideas can evolve over time as they delve into course work and clinical rotations, but the initial interests that guided them to medicine in the first place can be significant.

Envisioned by Yihan Lin, MD, MPH, a cardiothoracic surgery fellow in the CU Department of Surgery, the GlobalSurgBox gathers locally available resources in a toolbox-size container to help students and residents practice skills such as knot tying, basic suturing, and aortic valve repair.

For Courtney Mangham, who will soon complete her second year in the University of Colorado School of Medicine, her initial interest in global health guided her to a deeper interest in global surgery. This, in turn, led her to the GlobalSurgBox, a portable, economical training tool to help residents and medical students learn surgical skills.

Mangham got involved with gathering the materials for, assembling, and distributing the GlobalSurgBox during her first year of medical school. She recently presented research comparing data on GlobalSurgBox use in the United States, Kenya, and Rwanda at the Association of Program Directors in Surgery (APDS) conference in San

Courtney Mangham CU Medical Student

Antonio, Texas. She was awarded Best Medical Student Paper.

“I didn’t know I was competing for anything while I was presenting, which makes winning all the better,” Mangham says with a laugh. “But I feel very lucky that Dr. Lin, Dr. Michael Kirsch, and my colleagues trusted me to present something I believe in so much.”

Click here to discover more about Mangham’s award.

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Surgery News

REVISED CDC GUIDELINE FOR PRESCRIBING OPIOIDS SHOULD EMPHASIZE A MULTIDISCIPLINARY APPROACH TO MANAGING PAIN Matthew Iorio, MD, has researched alternatives to opioid use in post-surgical pain management and frequently sees effects of chronic pain in his surgical patients.

Rachel Sauer In 2016, the Centers for Disease Control and Prevention (CDC) issued the Guideline for Prescribing Opioids for Chronic Pain.

Since the guideline was released the abuse of opioids, including prescription opioids, has grown and increasingly been labeled not only an epidemic, but a crisis. According to National Center for Health Statistics data, between 1999 and 2019 nearly 247,000 people died in the United States from overdoses involving prescription opioids.

These issues have presented significant challenges for physicians and other health care providers as they seek to manage pain for patients and give the best quality of care.

Matthew Iorio, MD, associate professor of plastic and reconstructive surgery in the University of Colorado Department of Surgery, has conducted significant research on opioid reduction strategies and therapies for chronic phantom and extremity pain.

His research on the use of peripheral nerve catheters (PNC) during microvascular limb salvage surgery found that among study participants, PNC use for lower extremity free flap transfer significantly reduced concurrent narcotic use and shortened length of hospital stay. His research showed similar results using

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local anesthetic options for breast reconstruction surgery.

Further research found evidence that targeted muscle reinnervation therapies led to near-total resolution of neuroma pain in treating phantom limb syndrome following extremity amputation.

We recently spoke with Iorio about the challenges of pain management in light of the ongoing opioid crisis.

As a surgeon, you work with patients who experience or have significant potential for short-term and chronic pain. How does that inform the care you provide?

Much of my practice, probably 60% to 70%, is extremity preservation and reconstruction. And, whatever the reason a patient requires surgical intervention, and whether it happened yesterday or five, 10 years ago, a big problem for patients with prior amputations or major injuries are the huge doses of narcotics being prescribed for pain maintenance. It’s something people don’t commonly talk about, but a patient may have been on narcotics for a while and the idea of saying, “Hey, we’re going to reduce your narcotic intake” is

Matthew Iorio, MD Associate Professor Plastic & Reconstructive Surgery

really concerning. They may be homeostatic, and if they don’t take this level of opioids, they certainly feel the difference. So, an aspect of care is working with them in terms of tolerance and dependence. And to be clear, tolerance happens over time as a normal response from the body to many medications, and is not a sign of abuse. The problem is that we aren’t treating the pain, and opioids as a solution requires upward titration over time.

How does pain affect a patient’s recovery from surgery?

Pain is a problem not just because it exists, but because in post-operative recovery it diminishes what we’re able to do. If a patient is an 8 or 9 on the pain scale, they might not even be able to stand up. But if their pain is managed and they’re lower on the scale, they’re going to get out of bed faster, they’re going to be moving around sooner, they’re going to feel better. That’s the thing with pain, it’s multi-faceted.

Click here to read the complete interview with Iorio.

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July 2022 operations we could safely do with the resources that were available.”

Creating accurate risk prediction Meguid and his colleagues developed SURPAS so that surgeons and other clinicians could obtain accurate risk prediction models for several adverse outcomes following surgery. Prior to the development of SURPAS, pre-operative risk assessment was based largely on clinician experience.

ONLINE ASSESSMENT TOOL HELPS PREDICT ICU NEED FOLLOWING SURGERY Recently published research shows that a tool developed at the CU School of Medicine can accurately predict ICU need for a broad spectrum of surgical patients.

With SURPAS, which Meguid and his colleagues developed as a free online tool available to everyone, clinicians enter eight pre-operative risk variables to predict 30-day adverse outcomes following surgery. The eight pre-operative risk variables include surgical procedure, patient age, functional health status (a measure of how independent a patient is in their activities of daily living), American Society of Anesthesiology physical status classification, whether the patient will be admitted to the hospital after surgery, practitioner specialty, and whether the procedure is an emergency.

Rachel Sauer Even before the COVID-19 pandemic, intensive care unit (ICU) beds were in limited supply, and the pandemic only exacerbated this growing concern.

Since the pandemic began, ICU resources have been in such demand that clinicians across the United States and world have struggled to meet the need.

each patient before surgery. In turn, this allows clinicians to effectively plan hospital stays and avoid delays in patients’ care.

A particular concern for surgeons has been whether an ICU bed will be available for patients who may need one following surgery.

In recently published research analyzing surgical data from almost 35,000 patients, researchers found that when they input eight pre-operative variables into the Surgical Risk Preoperative Assessment System (SURPAS), the SURPAS model accurately predicted post-operative ICU use across nine surgical specialties.

However, a team of clinicians and researchers from the University of Colorado Department of Surgery found a solution using a risk assessment system they developed eight years earlier. Their work shows that the likelihood for post-operative ICU need can be accurately determined for

“The idea for this project really came about when ICUs were getting overwhelmed with COVID,” says Robert Meguid, MD, MPH, an associate professor of cardiothoracic surgery in the CU School of Medicine. “We were looking to determine which patients needed surgery sooner and which

Robert Meguid, MD, MPH Associate Professor Cardiothoracic Surgery

Paul Rozeboom, MD General Surgery Resident

Click here to read more about SURPAS.

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Surgery News devices that can be inserted by parents at home.

“Orthodontic techniques have evolved over the past decade or so, moving toward digital treatment modalities and the use of 3-D printing. It seems logical to utilize this technology to model what I’m doing for these infants on the computer,” she says. “My goal is to make treatment more predictable and accessible to families that aren’t able to come into the office.”

IMPROVING TREATMENT FOR INFANTS WITH CLEFT LIP AND PALATE New grant will help Kristen Lowe, DDS, MS, make nasoalveolar molding more accessible.

Greg Glasgow Kristen Lowe, DDS, MS, an assistant professor of plastic and reconstructive surgery in the University of Colorado School of Medicine, has received a grant from Align Technologies, the company that makes the Invisalign tooth-straightening system. The grant will support Lowe in developing more efficient ways to treat infants with cleft lip and palate.

Lowe currently treats infants with the congenital craniofacial anomaly — which affects one in 700 individuals worldwide — through a process called nasoalveolar molding (NAM), which uses an orthopedic appliance used to actively mold and reposition nose and mouth tissues before surgery.

“In the first few months of life, we can take a wide cleft and minimize the deformity,” she says. “We bring the gum 18

Kristen Lowe, DDS, MS Assistant Professor Plastic & Reconstructive Surgery

segments together, the lip segments together, and we shape the noses in these infants in preparation for their first surgical repair, which is traditionally at three to six months of life. The goal is to set up the patient for the best surgical result possible.”

Increasing access While effective, NAM is currently a laborious process that requires a dental impression be taken of the infant for appliance fabrication, followed by weekly office visits over the course of months for assessment and adjustments by a specially trained orthodontist. In her research funded

by Align, Lowe plans to develop a fully digital method for NAM that uses an intraoral scanning device to capture an optical impression of the mouth, and produce a set of 3-D printed NAM

Lowe will use her award to gather pilot data through a single-site clinical trial in order to develop the digital workflows and fabrication method for a digital NAM process.

Early intervention Patients with cleft lip and palate have problems chewing and speaking, as well as psychosocial challenges and often a significantly lower quality of life.

While there are certain risk factors for cleft palate, including maternal age, folic acid deficiency, and smoking and/ or alcohol use during pregnancy, in most cases the cause is unknown.

Addressing the facial deformity early is important because cartilage is much more moldable in infants from 0 to 6 months old. In addition to setting infants up for successful surgeries, the NAM process also helps infants with cleft lip and palate feed more easily.

“With cleft palate, the soft palate muscles aren’t working properly to create suction to allow the infant to feed,” Lowe says. “They cannot breastfeed, but there are specialized bottles that work by compression; milk is expelled as long as the baby or parent compresses the nipple.

However, this can be challenging, especially if the cleft is really wide.

When you have the appliance in, there’s a hard surface simulating the palate that allows the infant to more easily compress the nipple and feed better.”

Click here to read more about Lowe’s research.

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July 2022

A BETTER UNDERSTANDING OF SURVIVAL RATES FOR LUNG TRANSPLANT RECIPIENTS CU general surgery residents studied mortality rates between those who received transplants and those who did not.

Greg Glasgow For John Iguidbashian, MD, and Alejandro Suarez-Pierre, MD, general surgery residents in the Department of Surgery at the University of Colorado School of Medicine, the research started as a way to give patients who were eligible for lung transplants more accurate information about their life expectancy after the surgery.

“We were constantly counseling patients who needed lung transplants, and it was pretty obvious that the main thing they wanted to know is what their life would look like after the transplant and how long they would live,” Iguidbashian says. “All the papers that had already been written were giving 10-year survival rates, but nobody really studied how that compared to a general population that hadn’t received lung transplants.”

Looking at multiple factors To help answer this question, the two started their own research study, looking at survival rates for lung transplant patients versus adults who didn’t receive a lung transplant, further classifying the results by factors including age, gender, race, and socioeconomic status. The resulting paper was published in the May issue of the Journal of Cardiac Surgery.

Iguidbashian and Suarez-Pierre used data from the U.S. Census Bureau’s National Longitudinal Mortality Study to get information on death rates of nonhospitalized adults, and they obtained numbers from the Organ Procurement and Transplantation Network to calculate mortality rates for patients who underwent lung transplantation. To ensure a robust

control group that accounted for all variables, they gathered data on five nonhospitalized adults for every one lung transplant recipient.

John Iguidbashian, MD General Surgery Resident

“The ultimate result of this study was that the standardized mortality rate is approximately five times higher for transplant recipients, which is a lot,” Suarez-Pierre says.

One reason for the discrepancy is that lung transplant recipients take immunosuppressive medications so their immune systems will not reject the new organ, leaving them more susceptible to infections.

“There are viruses and bacteria that are usually not a problem for healthy people that can be a very severe problem for transplant recipients,” Suarez-Pierre says.

The body’s rejection of the new lung is another common cause of death, as is pneumonia. The study showed that death from strokes or heart attacks is actually lower in the transplant population, a statistic Suarez-Pierre and Iguidbashian attribute to the rigorous health screening lung transplant recipients undergo prior to being approved for the procedure.

Uncovering health disparities A concerning finding from the study was that Hispanic lung transplant recipients have a tenfold increase in mortality compared to Hispanic healthy individuals in the U.S. — double the number in other ethnic groups.

Alejandro Suarez-Pierre, MD General Surgery Resident

underway to dig more deeply into the numbers.

“For example, if you’re a lung transplant recipient but you don’t have a private vehicle to go to your doctor’s appointments, you may miss your doctor’s appointments or not be able to pick up your medications,” Suarez-Pierre says. “Or if you live in a household where most of the people in the household are unemployed and there’s a one person who is responsible for everybody else financially, that could also affect you. We want to understand what the barriers are, and also which barriers are low-hanging fruit so we can start to tackle this problem.”

Click here to learn more about their research.

The researchers theorize that may have a lot to do with social determinants of health, and they have another study 19

Surgery News

LIVING ORGAN DONATION JOURNEY INSPIRES DOCTOR TO NORMALIZE THE EXPERIENCE FOR OTHERS Rachel Davis, MD, donated the right lobe of her liver to a stranger as a way to pursue her life values and purpose.

Rachel Sauer At first, she was reluctant to talk about it – a little sheepish, even. The obvious question was, “Why are you doing this?” And though she had answers, none of them were quick or easy.

bragging to talk about it. It just feels meaningful and exciting, and it’s not something that needs to be hidden.”

Taking risks that align with her values

The simplest explanation that Rachel Davis, MD, associate professor of psychiatry in the University of Colorado School of Medicine and vice chair of Clinical Affairs, could give for donating more than 50% of her liver to a stranger is that she wanted to and she was able to.

Davis, who grew up on the plains of eastern Colorado, has always been motivated to work hard and excel in everything she did. She knew from a young age that she wanted to be a doctor and determinedly pursued a path to medical school.

“I don’t feel comfortable with this donation being portrayed as selfless or heroic,” Davis says. “While donating part of my liver offered me no medical or physical benefit, the experience has provided immense psychological and even spiritual benefit.”

It was during her medical studies that she first learned about living organ donation, and, “I remember thinking, ‘I need to do this,” Davis says. At the time, nondirected living donation, or donation in which the organ does not have an intended recipient, wasn’t common or really even discussed.

More than two months since her surgery, Davis has grown increasingly comfortable talking about her living donation journey as a way to “normalize the experience and the option of living donation,” she says. “I’m no longer embarrassed, and it no longer feels like

Despite her desire to donate, the demands of medical school couldn’t accommodate a commitment as significant as living organ donation. But it was something Davis always kept in the back of her mind.

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Elizabeth Pomfret, MD, PhD Professor & Chief Transplant Surgery “I’m not a thrill seeker or adrenaline junkie, but I have taken a number of risks throughout the course of my life, all in line with my values and sense of purpose in life,” she explains.

These have included working in a Mozambique orphanage shortly after the civil war there ended and traveling through Madagascar when the country was experiencing plague outbreaks.

So, when she came across an article on the UCHealth website about a nondirected living organ donor, she decided it was time to seriously pursue the thing she’d been thinking about for years.

Click here to read more about Davis’ journey.

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